- Enrollment id
- O20221026000852
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1295305498
- Multiple npi flag
- N
- Ccn
- 757112
- Associate id
- 9537535968
- Organization name
- RADIANT LIGHT HOME HEALTH INC
- Incorporation date
- 2021-05-31
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2600 FOOTHILL BLVD
- Address line 2
- STE 305
- City
- LA CRESCENTA
- State
- CA
- Zip code
- 912144579